An Expert Opinion on Perineal Re-Education

Midwife Lucile Rebeirot

There’s a long-standing cliché around the world that in France, women get special treatment down there after giving birth to bring their sex life back to normal. A simple online search of the terms ‘perineum’ and ‘France’ bring up firsthand accounts of those looking to make France seem like some enviable type of real-life sex shop, telling the story of how they went through sessions of perineal coaching to get back on track under the sheets.

Sorry to disappoint those looking for a modern-day Dangerous Liaisons, but here’s the truth: after childbirth, a woman’s pelvic floor simply isn’t what it used to be. For these women, that can mean anything from incontinence to a general feeling of heaviness and discomfort. In France, perineal re-education has been used a solution to prevent, and treat, these issues for decades.

Paris-based midwife Lucile Rebeirot agreed to lend a hand in debunking the myths and bringing some truth back into the way we look at perineal physical therapy.

Let’s start with the basics. What is perineal re-education, and why is it important?

The perineum is a group of muscles located inside the pelvis that surrounds the urogenital canals of both men and women. During pregnancy, a lot of weight is placed on the perineum: the baby, first of all, but also the placenta, amniotic fluid, etc. During childbirth, the perineum goes through a lot.

Perineal re-education is physical therapy for this particular group of muscles, so they can keep doing what they’re supposed to: ensure continence and help organs of the pelvic area stay in the right place.

What’s this whole thing about perineal re-education having the primary goal of sexual satisfaction? We’ve even heard some say that it was created specifically with husbands in mind…

Physical therapy strengthens the muscles located at the entry of the vagina. While this may assist with sex after childbirth, it isn’t the raison d’être. However, it’s time to put the cliché of sex for the husband to rest.

“If anyone benefits sexually from perineal re-education, it’s the women.”

What about the idea that physical therapy of the perineum isn’t actually useful?

That’s another myth I’d really like to see disappear. It bothers me to hear that re-education isn’t necessary as long as you don’t have incontinence issues. How about we start listening to our bodies before the important and bothersome symptoms show up?

This whole process is covered by the national health care system in France, right?

Childbirth has a traumatic impact on the perineum. When you hurt your knee skiing, physical therapy is covered by insurance here. Why should it be any different? Though the perineum isn’t as visible as a limb, there can be lifelong consequences when it is hurt or damaged. Physical therapy in this case is a need, not a nice to have.

Can you walk us through a perineal re-education session?

Before we start, I explain to all patients that everyone has the ability to voluntarily contract each individual perineal muscle. Throughout the process, women learn various exercises to strengthen and tone the muscles. These methods can be used for the rest of your life.

In specific cases (such as after the birth of multiples), midwives might use an electro stimulation probe to help with muscle tone.

What would you recommend for women who don’t have access to this type of physical therapy?

Nothing can truly replace the benefit of a full program of perineal re-education sessions, but everyday awareness of the perineum is key. Before carrying something heavy, sneezing, or coughing, I recommend ‘locking up’ the perineum (the same type of movement as when you interrupt urine flow).

Yoga and Pilates are another great way to gain awareness of the perineum, especially after childbirth.

For more information on Rebeirot and how midwives accompany women through pregnancy, visit her website: www.sagefemme-rebeirot.com

Coming up, a firsthand account of perineal re-education, the invisible workout.